Comparative analysis between combination and single-agent chemotherapy for elderly patients with advanced non-small cell lung cancer: a nationwide population-based outcome study
Menée en Corée à partir de données portant sur 7 298 patients atteints d'un cancer du poumon non à petites cellules de stade avancé et âgés de plus de 70 ans, cette étude compare l'efficacité de chimiothérapies utilisant un agent en monothérapie et celles utilisant plusieurs agents en combinaison
Introduction : To determine whether an upfront combination compared to single-agent therapy is beneficial for elderly patients with advanced non-small cell lung cancer (NSCLC) in the real world, a population-based epidemiologic study was conducted. Methods : Patients ≥70 years with advanced NSCLC from 2007 to 2012 were identified in the National Health Insurance Service Database of Korea. A Cox proportional-hazards regression model and propensity score analysis were used to examine the effect of treatment modality on survival. Results : Among 41,276 patients newly diagnosed with lung cancer, 8,274 (20.0%) identified to be treated with upfront palliative chemotherapy were eligible for this study. After excluding 976 patients who received a first-line anti-epidermal growth factor receptor (EGFR) treatment, 7,298 (88.2%) who received cytotoxic chemotherapy were included in further analyses: 5,636 (77.2%) received doublet chemotherapy and 1,662 (22.8%) received monotherapy. The most frequent regimen in combination group was gemcitabine and platinum doublet (44.7%), whereas that in monotherapy group was gemcitabine (46.7%). Multivariate analyses indicated lower use of combination chemotherapy with increasing age (odds ratio[OR] 0.73; 95% CI 0.67–0.79; P <0.001) and female sex (OR 0.71; 95% CI 0.62–0.80; P <0.001). Receipt of combination over single-agent chemotherapy was associated with a reduced risk of death (hazard ratio [HR] 0.91; 95% CI 0.86–0.96; P = 0.001) in overall population and (HR 0.89; 95% CI 0.80–0.98; P = 0.019) in the propensity-matched cohort. Conclusion : In elderly patients with advanced NSCLC excluding those receiving frontline anti-EGFR targeted agents, receiving initial combination chemotherapy compared to single-agent was associated with improved survival.
Lung Cancer 2018